Chronic renal insufficiency (CRI) has been associated with an increased risk of cardiovascular disease in some studies, but the relation of CRI to cardiovascular mortality in the United States is not known. The contribution of CRI to cardiovascular disease mortality may be greatest in the elderly and in blacks, because CRI is more prevalent in these groups. Furthermore, the pathologic mechanisms for the increase in all-cause mortality associated with CRI are largely unknown. This project will help to define the effect of CRI on cardiovascular public health in the United States, and will evaluate the potential underlying mechanisms. Using data from the Second National Health and Nutritional Examination Survey Mortality Study, this project will estimate the independent association of CRI with cardiovascular mortality in the United States, and the contribution of CRI (the population attributable risk) to cardiovascular mortality within subgroups based on age, race and sex. Further analyses will compare the different methods for defining CRI, based on serum creatinine, estimated creatinine clearance, and estimated glomerular filtration rate. The association of each measurement of renal function with cardiovascular mortality will be characterized by subgroups of age, race and sex. This project will also examine the association of CRI with potential traditional and novel cardiovascular risk factors, using data from the Third National Health and Nutritional Examination Study. The hypothesis that CRI is associated with unique abnormalities, including inflammation, metabolic alterations, and dyslipidemia, will be evaluated by comparing serum measurements in participants with and without CRI.